Utliization Review Specialist
Utliization Review Specialist
AZ-Phoenix-Crisis Recovery Unit I
Southwest Behavioral & Health Services is a large and growing, non-profit community-based provider of behavioral health services with locations throughout the Phoenix metropolitan area, rural Maricopa County, Gila, Pinal, Mohave, Coconino, and Yavapai Counties. We are a well-established voice in the community with more than 115 sites, over one thousand employees, and 40 years’ experience.
Join Southwest Behavioral & Health for exceptional growth opportunities driven by our promote-from-within philosophy. We provide an EXCELLENT compensation and benefits package, including immediate participation in our 403(b) program with 20% company match after 1 year of service. Generous Paid Time Off (PTO) includes 3 weeks of time-off your 1st year (available after 6 months) and increased vacation accruals after 2, 5 and 10 years of service! We offer low cost medical insurance and offer 100% company-paid dental, Short Term Disability, Long Term Disability, and Life coverage for employees. Other great benefits include 10 paid holidays, vision, licensure/certification reimbursement, tuition reimbursement, prescription drug discounts, chiropractic services, 100% paid Employee Assistance Program, and much more!
We are currently looking for a Utilization Review Specialist to join our Crisis Recovery Units and Recovery Transition Program! This is a full-time position working four 10-hour shift. Schedule will be Sunday through Wednesday.
Working as a Utilization Review Specialist, you will complete necessary paperwork at the time of admission, during stabilization and at discharge. Serves as primary staff responsible for utilization review/ quality assurance activities. Performs chart audits, utilization review activities, discharge coordination as needed. These functions include clinical care coordination between resources within and outside the agency, monitoring the programs’ compliance with inpatient rules and regulations.
Duties & Responsibilities:
- Completes Certificate of Need (CON), and Re-Certification of Need (RON) documents.
- Daily contact with RBHA to secure authorizations and/or Letters of Authorization (LOA) for consumers stays documentation of contact in authorization log and follows up when necessary with the T/RBHA.
- Obtains authorizations from T/RBHAs and insurance plans when necessary.
- Works collaboratively with Behavioral Health Medical Practitioners, Psychologists, Registered Nurses, CRU Care Coordinators, UM/QM Director, and Behavioral Health Technicians.
- Follow up with internal and external agencies to address issues related to eligibility and enrollment.
- Follow up with BHMPs, Care Coordinators, and nurses to ensure clear documentation of medical necessity in charts.
- Daily tracking of all authorizations, with use of Excel spreadsheet, to ensure correct authorization numbers and dates of service.
- Daily communications with fund sources to secure authorization for inpatient services. Trouble shoots and resolves barriers with securing authorization for inpatient services.
- Initiates and oversees retro and reconsideration authorization processes to ensure authorizations for inpatient services are secured timely.
- Collects referral information regarding those referred for CRU services.
- Completes medical record reviews for division (re: inpatient, residential, and outpatient services).
- Completes Discharge Ready and Crisis Report of Discharged Patient Reports.
- Works with a multi-disciplinary team on discharge planning activities.
- Assesses consumers in accordance with established policies and procedures and clinical protocols.
- Develops and maintains appropriate level of relationships with consumers and formal/informal support systems.
- Notifies shift supervisor of actual or potential challenges with consumers; i.e., non-compliance, decompensation, and crisis immediately.
- Collects eligibility information regarding those referred for CRU services.
- Provides face-to-face crisis intervention as needed.
- Maintains accurate, thorough and current documentation of contact with consumers, treatment progress and services received/provided.
- Ensure CONFIDENTIALITY in all areas of service corporate wide.
- Attends Utilization, Care Coordinator, and “All Staff” meetings (on site) as scheduled.
Education and Qualifications:
- Minimum requirement consists of a Bachelor’s degree with two years of full-time behavioral health experience. Utilization Review and/or case management experience with adults and/or special populations required.
- Valid AZ driver’s license & Motor Vehicle clearance.
- An equivalent combination of education and experience directly related to behavioral health totaling six years is acceptable.
- Demonstrates advanced understanding of and ability with Microsoft Office Suite.
- Knowledge of computer software and/or applicable programs.
Job Reference #: 4366